Why Thyroid Disorders Are Often Missed in Older Adults
Fatigue, change in mood, hair and nail changes, weight changes, and memory issues. Sound like signs of aging? Maybe not. These are also signs of a malfunctioning thyroid — a condition that can be easily mistaken for other reasons in older adults. Accurately identifying and treating thyroid diseases in seniors requires special attention. Common thyroid disorders in the elderly include:
- Hypothyroidism, in which the thyroid is underactive and not producing enough thyroid hormone for the body to work properly. The most common cause of hypothyroidism is an autoimmune disorder, Hashimoto’s thyroiditis. Thyroiditis is a broad term referring to inflammation of the thyroid gland. Within the United States, Hashimoto’s thyroiditis is the most prevalent cause of hypothyroidism. If the thyroiditis causes slow and chronic cell damage, thyroid hormone levels in the blood drop and cause symptoms of hypothyroidism. Hypothyroidism’s symptoms are nonspecific and may include weight gain, sleepiness, dry skin and constipation.
- Hyperthyroidism, which occurs when the thyroid is overactive and releasing too much thyroid hormone and speeding up body systems. In younger people, hyperthyroidism typically presents with increased appetite, weight loss, rapid heartbeat, sweating, irritability and tremor. In the United States, the autoimmune disorder Graves' disease is the most common cause of hyperthyroidism. In older adults, it can also be caused by a thyroid nodule that makes too much thyroid hormone (toxic nodule), or thyroiditis (inflammation causing leaking of thyroid hormone into the blood system). If there is accelerated cell damage, thyroid hormone in the thyroid gland leaks out and increases levels in the blood, which can cause hyperthyroidism.Older adults often have symptoms of fatigue, apathy, and irregular or rapid heartrate, which can misleadingly appear more like hypothyroidism.
- Thyroid nodules, an abnormal growth of thyroid cells within the thyroid gland that can form a lump, or what is called a “thyroid nodule.” These nodules are predominantly noncancerous but need to be evaluated by a physician to determine the possibility of thyroid cancer. Thyroid nodules generally do not cause symptoms and are often detected incidentally during a routine physical or neck scan for other health reasons. Conditions like Hashimoto’s disease and iodine deficiency increase the risk for thyroid nodules.
- Thyroid cancer, which is a malignant tumor on the thyroid gland. There are several types of thyroid cancer including papillary, follicular, medullary and anaplastic. The most common type is papillary thyroid carcinoma and is very treatable, but aggressiveness of the tumor can increase with age. It can present as an asymptomatic neck mass or can be detected incidentally on imaging done for other reasons. In contrast, anaplastic thyroid cancer is the most aggressive thyroid cancer and occurs most commonly in people over age 60. Fortunately, anaplastic thyroid cancer is quite rare, occurring in less than 2 percent of thyroid cancer patients. Anaplastic thyroid cancer can present as a rapidly growing neck mass that can cause hoarseness and difficulty with swallowing or breathing.
Guidelines for screening for thyroid disease are conflicting, but societies agree that if persons are having symptoms that could be attributable to an overactive or underactive thyroid, further workup is indicated.
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